Do i need to take a blood pressure medication like ramipril, if i dont have hypertension, but only have lad 40% ef 49% mildly left atrium dilated, moderate regurgitate of mitral valve?

ACE inhibitors like ramipril have been demonstrated to reduce hospitalizations & mortality in patients with low EF. In addition they have been shown to reduce ventricular strain & enlargement in the presence of chronic mitral regulation. I'm unsure what type of cardiomyopathy you have, but ramipril should help you. Your cardiologist can advise you best,however.

Depends on what your Dr thinks is going on. ACESs re used to treat many things besides HBP. Including LVH. What do you define as hypertension. Anything above 120/80 is now called high blood pressure of one type or another. Ask why do you have LVH if nt from HBP. Get BP checked in both arms. They can differ by 50 mm Hg.